Effects of depression and anxiety on quality of life in adults with heart failure and their caregivers using the actor partner interdependence model

Abstract Background Heart failure (HF) impacts both patients and their caregivers, often leading to increased levels of depression and reduced quality of life. Dyadic analysis provides a robust framework for exploring the interdependent relationships between HF patients and their caregivers, particularly in understanding how their psychological well-being affects each other. Objective This study employs the Actor-Partner Interdependence Model (APIM) to examine predictors of quality of life in HF dyads using the WHO Quality of Life (WHOQOL) questionnaire. Methods Data were collected from HF patients and their primary caregivers (N = 104 dyads). Depression and anxiety were assessed using a validated depression scale (HADS), while quality of life (QoL) was measured using the WHOQOL that covers four domains: physical, psychological, social and environmental. Coping was measured using the Dyadic Coping Inventory (DCI). Dyad’s demographic characteristics were also collected. Dyadic data were entered into SPSS for descriptive statistics and preliminary analyses. Structural equation modeling (SEM) was conducted using the R package lavaan to analyze actor and partner effects within the APIM framework. Actor effects refer to the impact of an individual's predictors (e.g., depression and anxiety) on their own outcomes, while partner effects capture the influence of one individual's predictors on the outcomes of their dyadic partner. Results Findings indicate significant actor effects for both patients and caregivers for depression, with higher depression levels associated with lower QoL scores on all subscales (Physical: bcaregiver = -2.436, bpatient = -2.756; Psychological: bcaregiver = -2.286, bpatient = -2.728; Social: bcaregiver= -2.676, bpatient = -2.008; Environmental: bcaregiver = -1.988, bpatient = -1.858). Actor effects were also shown for anxiety levels for both patients and caregivers, with higher anxiety associated with lower QoL scores on physical (bcaregiver = -0.906, bpatient = -1.141), and psychological (bcaregiver = -0.876, bpatient = -0.793); and only for patients on environmental (bpatient = -0.655). As for Partner effects, they revealed that a patient’s DCI significantly predicted the caregiver’s physical health (bpatient = -0.247). Conclusion The APIM model provides valuable insights into the interdependence of HF dyads, emphasizing the need for interventions targeting both members to improve psychological well-being and quality of life. Future research should explore longitudinal designs to further understand these dynamics over time.